Expert Recommendations
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2020; 12(9): 256-265
Published online Sep 16, 2020. doi: 10.4253/wjge.v12.i9.256
Endoscopy during COVID-19 pandemic: An overview of infection control measures and practical application
Margaret Teng, Si Ying Tang, Calvin Jianyi Koh
Margaret Teng, Si Ying Tang, Gastroenterology and Hepatology, National University Hospital, Singapore 119228, Singapore
Calvin Jianyi Koh, Division of Gastroenterology and Hepatology, National University Health System, Singapore 119074, Singapore
Author contributions: Koh CJ, Teng M and Tang SY contributed equally to this work; Koh CJ conceptualized the article; Koh CJ, Teng M and Tang SY wrote the manuscript; all authors have read and approve the final manuscript.
Conflict-of-interest statement: None of the authors have any references to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Calvin Jianyi Koh, MBBS, MRCP, Assistant Professor, Doctor, Division of Gastroenterology and Hepatology, National University Health System, 1E Kent Ridge Road, Singapore 119074, Singapore. calvin_j_koh@nuhs.edu.sg
Received: May 21, 2020
Peer-review started: May 21, 2020
First decision: June 13, 2020
Revised: July 29, 2020
Accepted: August 31, 2020
Article in press: August 31, 2020
Published online: September 16, 2020
Abstract

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in coronavirus disease 2019 (COVID-19) which has affected more than 4.5 million people in 213 countries, and has been declared a pandemic by World Health Organization on March 11, 2020. The transmission of SARS-CoV-2 has been reported to occur primarily through direct contact or droplets. There have also been reports that SARS-CoV-2 can be detected in biopsy and stool specimens, and it has been postulated that there is potential for fecal–oral transmission as well. Gastrointestinal symptoms have been reported in 17.6% of COVID-19 patients and transmission can potentially occur through gastrointestinal secretions in this group of patients. Furthermore, transmission can also occur in asymptomatic carriers or patients with viral shedding during the incubation period. Endoscopic procedures hence may pose significant risks of transmission (even for those not directly involving confirmed COVID-19 cases) as endoscopists and endoscopy staff are in close contact with patients during these aerosol generating procedures. This could result in inadvertent transmission of infection at time of endoscopy.

Keywords: Coronavirus, Endoscopy, Infection control, Personal protective equipment, Guidelines, Gastroenterology

Core Tip: Coronavirus pandemic has united the world in taking enhanced measures in the endoscopy center to limit the spread of disease. However, considerable variation exists in the society recommendations that have come out of United States, Canada, Europe, United Kingdom, Australia, Asia and Japan. We summarize these recommendations, provide an overview, and describe our practical application of endoscopy in this challenging times.